NC House bill would expand access to early screening for prostate cancer

Sherrie Wood and her husband, Kenneth, were newly married when he was diagnosed with prostate cancer in 2003. He experienced extreme back pain and problems with urinating for over a year, but his general practitioner only treated the symptoms. After all, he was only in his early 40s.

They were finally referred to a urologist, and that doctor also didn’t think he had cancer because he was so young. But the second urologist they saw diagnosed Kenneth with stage 4 prostate cancer.

The couple’s focus immediately shifted, Sherrie Wood said, from trying to have a baby to getting treatment for Kenneth’s cancer. He underwent radiation, but the cancer came back multiple times. Kenneth died in 2005.

“I didn’t plan to be a widow in my 30s,” Wood, who lives in Stanly County, said.

Raising awareness about early screening is vital, she added, because it can mean the difference between life and death. Rodney D. Pierce, D-Roanoke Rapids, a new member of the North Carolina House of Representatives, filed House Bill 128 in early February that would expand access to prostate cancer screenings to underinsured or uninsured men in the state.

Prostate cancer is the second leading cause of cancer deaths in North Carolina men, according to the UNC Chapel Hill Men’s Health Program. The state ranked 11th highest in the U.S. for rates of new cases in 2023, and the North Carolina Department of Health and Human Services estimated that more than 1,100 men would die from prostate cancer in the state in 2023.

Almost all men whose cancer is found early survive for five years and beyond, but only 34 percent of men who are diagnosed after it has spread survive for five years and beyond. Black men are also more likely to be diagnosed with prostate cancer and more likely to die from it than white men.

House Bill 128 aims to remove barriers to testing and raise awareness about prostate cancer, Pierce said.

Deaths across the state

House Bill 128 would appropriate $4 million between 2025 and 2027 to the state Department of Health and Human Services to establish and administer a prostate cancer control program. The program would provide free or low-cost prostate cancer screenings and follow-up care to men who are uninsured or whose insurance won’t cover this kind of screening and who have a single-person household income below about $37,600.

Men who are between 50 and 70 years old without family history of prostate cancer are eligible for the program. Men with such family history are eligible when they’re 40.

Pierce modeled his bill after the North Carolina Breast and Cervical Cancer Control Program, which provides free or low-cost screenings and follow-up care to eligible women in the state.

Pierce said introducing the bill was especially important to him because the area of the state he represents — an area he calls “the neglected Northeast” — has high rates of prostate cancer.

Halifax County, part of his constituency, has one of North Carolina’s highest rates of deaths from prostate cancer, according to the 2023 Prostate Cancer Report from UNC Chapel Hill.

The counties with the highest rates of deaths due to prostate cancer in 2023 — between 27 to 31 deaths per 100,000 men — were Granville, Halifax, Edgecombe, Martin, Chowan, Hertford, Pasquotank and Yancey. In contrast, Ashe, Watauga, Buncombe, McDowell, Columbus and Carteret counties have some of the lowest death rates in the state: around 11 to 15 deaths per 100,000 men.

Many of those Northeastern counties also had higher rates of new cases than other parts of the state.

Controversial history behind the test

The prostate-specific antigen, or PSA, test is primarily used to diagnose prostate cancer. The antigen is produced both by normal and malignant cells of the prostate gland, according to the National Institute of Health. Prostate cancer can elevate those levels.

North Carolina State University alum T. Ming Chu led the research that developed the PSA test in the 1970s, and the FDA approved it as an early detection tool in 1994, according to Technician, a student-run publication at the university.

Before the PSA test, prostate cancer typically went undetected until the patient had symptoms or a doctor could detect it with a physical exam. By that point, it was often incurable. The test was “transformational,” said Matthew Nielsen, a urologist who chairs the urology department at the UNC School of Medicine at Chapel Hill.

Once men started receiving PSA tests, he said, the fraction of those diagnosed with metastatic cancer, or cancer that has spread to other parts of the body, dropped dramatically.

The test was widely used in the early years of its adoption, but it eventually generated controversy, Nielsen said. Many men have a low-risk, slow-growing type of prostate cancer that might not require immediate treatment. But upon hearing they had cancer, some frightened patients panicked and wound up going forward with surgery or radiation treatments with side effects that could cause more harm than good.

Concerns of overdiagnosis and overtreatment led the U.S. Preventive Services Task Force — a federal group that reviews all the data to find the best recommendations — to recommend against using the PSA test in all men in 2012.

But that “might have thrown out the baby with the bathwater,” Nielsen said.

As PSA testing rates dropped, so did the rates of new cases, he said. In the last few years, though, the incidence rates have increased, and more than half of that increase is in men diagnosed with metastatic disease.

Now, active surveillance helps balance concerns of overtreatment, Nielsen said. Health care providers have better insight into the risk level for a patient’s particular prostate cancer, and they can give patients the option of waiting on treatment, with frequent follow up to make sure more aggressive cancer hasn’t developed.

Pushing early detection

Almost two decades after her husband’s death, Wood started dating a man named Michael. Two months into the relationship, he was diagnosed with stage 4 prostate cancer.

Michael told her she could walk away — but Wood said since she’d already been through this once, she knew how to navigate the system. Michael received six months of chemotherapy and is in remission. They got married in December 2022.

Now, Wood pushes the men in her life to keep getting tested so that if they do have prostate cancer, it’s caught early. Her father and her late husband’s brother were both diagnosed.

Wood said she can understand how people without insurance might not want to go to the doctor, but “hiding your head in the sand” won’t keep someone healthy, either.

“Nobody wants to get it at stage 4 — I can tell you, I’ve been through that twice,” she said.

Catching the cancer early is key. Yet there’s sometimes a stigma around prostate cancer testing, Pierce said.

Men tend to downplay the importance of screening, often because of societal pressures, according to the UNC Men’s Health Program. Affording care is another barrier to regular preventative health appointments.

Passing this bill would at least remove the financial barrier — if not the mental one, Pierce said.

Most people get the PSA test from their primary care provider, Nielsen said. He works with primary care physicians to explain the value of PSA testing to those who may still be wary of overdiagnosis and overtreatment.

Fighting racial disparities

Expanding access to testing may also help address some of the gap between Black men and other groups when it comes to prostate cancer. Black men are 1.7 times more likely to get diagnosed and 2.3 times more likely to die compared with white men, according to the UNC Chapel Hill prostate cancer report card.

One factor in that gap might be genetics; men of African ancestry in many parts of the world have higher rates of prostate cancer, Nielsen said. Even in settings where men of different races have equal access to care, Black men have higher rates of diagnosis.

Access to care and factors such as socioeconomic status, education, employment and social support also play a role, he said.

“The single greatest opportunity to address that disparity from prostate cancer is better access to the PSA test,” Nielsen said.

Rates of Black men taking the PSA test are still lower than other groups, despite their higher risk, he said.

The bill’s aim of getting more men access to the test sounds like a good idea, Nielsen said, because the overall goal is to make those sobering statistics better for the next generation.

Next steps

House Bill 128 has been introduced but has yet to be heard in any legislative committee.

Reps. Timothy Reeder, R-Ayden, an emergency room physician, and Grant Campbell, R-Concord, an obstetrician-gynecologist, are co-sponsors of the bill. Rep. Mark Brody, R-Monroe, another co-sponsor, represents Anson County, which had the highest rate of new prostate cancer cases in the state in 2023.

Pierce said the bipartisan support in the House is a good sign. Sen. Kandie Smith, D-Greenville, said she would support the bill if it made it to the Senate, Pierce said.

“I would hope and pray that my male colleagues will say, ‘This is about saving the lives of not only men we know — our nephews, fathers, grandfathers, uncles, brothers — but also ourselves, possibly,’” he said.